Psychosocial Evaluation Research Articles

Reliability of the Cleveland Clinic Behavioral Rating System (CCBRS) Among Diverse Patients Seeking Bariatric Surgery.

The CCBRS is a multidimensional assessment tool developed to aid in the psychosocial evaluation of patients seeking bariatric surgery. To date, three studies support the interrater reliability, internal consistency, and predictive validity of the CCBRS for a number of postoperative outcomes. However, research has predominantly been with White females. This study examines the reliability of the CCBRS with diverse individuals from three surgery clinics. The relative contribution of demographic and psychosocial variables to overall CCBRS ratings and differences in overall CCBRS ratings based on these factors are also explored. Patients seeking bariatric surgery (n = 407; 86.2% female; 49.6% Black; mean BMI 48.3kg/m2, SD = 8.5) were evaluated with a standardized multimodal assessment. CCBRS domain and overall ratings were made based on the integration of assessment data. Patient weight, BMI, and weight loss surgery procedure were obtained from the initial bariatric surgery consult. Internal consistency of the CCBRS was good (Cronbach's alpha = .80) for this sample though lower than previously found. Most patients (75.6%) were cleared for surgery. Statistically significant differences in overall CCBRS ratings were found only based on employment status and referring clinic. Hierarchical regression analysis demonstrated a small effect for demographic and psychosocial factors, with only past alcohol abuse, current substance abuse, and referring clinic explaining statistically significant variance in overall CCBRS ratings. Results support the reliability of the CCBRS; however, additional research is needed with diverse populations.

Prevention of Trafficking in Organs, Tissues, and Cells.

Trafficking in human organs, cells, and tissues has long been a source of concern for health authorities and professionals, and several international ethical guidance documents and national laws have affirmed the prohibition of trade in these substances of human origin (SoHOs). However, despite considerable attention to the issue of organ trafficking, this remains a substantial and widespread problem internationally. In contrast, trafficking in cells, tissues, and medical products derived from SoHOs has received comparatively little attention, and the extent and nature of such trafficking remain largely unknown. Consequently, as part of the 2023 Global Summit on Convergence in Transplantation held in Santander, Spain, an ethics working group was assigned the task of formulating actionable recommendations to support the prevention of trafficking in all SoHOs. In reporting on this work, we review factors that may influence the persistent trafficking of SoHOs, explore the potential difficulties associated with the collection and reporting of data about suspected trafficking activities, and argue that more practical and consistent guidance, training, and regulatory frameworks are needed internationally to support effective reporting, sharing of data, and collaborative responses to suspected trafficking cases. We also discuss the importance of psychosocial evaluation of living donors as a strategy to detect and prevent organ trafficking and strive to advance the implementation of this well-established recommendation by outlining minimum standards for psychosocial evaluation of living donors.

Enhancing Cancer Supportive Care: Integrating Psychosocial Support, Nutrition, and Physical Activity Using Telehealth Solutions.

This review explores current guidelines for integrating psychosocial support, nutrition, and physical activity into cancer care and examines the resources available to deliver comprehensive care effectively and equitably, with a focus on telehealth solutions. A review of current guidelines related to psychosocial support, nutrition, and exercise in oncology published between the years 2020 and 2024 was conducted. Additionally, relevant articles from the authors' personal archives were included. Current guidelines emphasize routine psychosocial distress screening, nutritional assessment, and tailored physical activity interventions for patients with cancer. The National Comprehensive Cancer Network and ASCO highlight the need for regular psychosocial evaluations and the management of common psychiatric disorders. The American Cancer Society and the Academy of Nutrition and Dietetics recommend nutritional screening, personalized counseling, and exercise to improve treatment tolerance and overall quality of life. Despite these recommendations, challenges such as resource limitations, time constraints, and financial barriers hinder their implementation. Integrating psychosocial support, medical nutrition therapy, and physical activity into cancer care is essential to enhancing patients' quality of life. Telehealth offers a viable solution to overcome barriers by providing remote access to supportive services, facilitating comprehensive care, and promoting patient engagement. The effectiveness of telehealth in delivering psychosocial, nutritional, and physical activity support highlights its potential to improve patient outcomes and overcome barriers to care. Telehealth technologies hold high potential to optimize cancer care delivery, ensuring personalized support for patients throughout their cancer journey.

Demographic and clinical characteristics of New York City Health + Hospitals HIV Heart Failure (NYC4H cohort): cohort profile.

Studies have elucidated that heart failure (HF) in people living with HIV manifests differently when compared with HF cases in the general population. This cohort aimed to examine the mortality risk factors, including biological and social factors, as well as suitable medical interventions to prevent death in this population. The New York City Health+Hospitals HIV Heart Failure (NYC4H) cohort encompassed records from 11 major hospital sites. Adult individuals with confirmed HIV and HF were recruited from either inpatient or clinic hospital visits between July 2017 and June 2022. The first follow-up period began on the date of the first clinical encounter until June 2023, and the second follow-up period extended between July 2022 and October 2023. In total, 1044 patients were enrolled in the study. The cohort comprised 657 (62.9%) males and 387 (37.1%) females. The average age was 61.6 years at baseline and the average follow-up time was 3.8 years. Overall, a total of 259 (24.8%) deaths were identified, of which 193 occurred in the first follow-up period (enrolling date to June 2022) and 66 during the second follow-up period (June 2022 to October 2023). The most common comorbidities within this population were hypertension (75.3%), chronic obstructive pulmonary disease (39.2%), type II diabetes mellitus (40%) and hyperlipidaemia (35.7%). The most common social adversities were polysubstance use (31.13%), mental health-related issues (20.7%) and lack of family support (14.5%). 601 (57.6%) patients had encountered at least one and more than one social adversity in their lifetime. Currently, nutritional notes from licensed dietitians and right and left heart catheterisation reports are under review. We are scheduled to complete the data collection for the comprehensive third follow-up period, which includes follow-up psychosocial evaluations, by the end of 2025. In addition, we intend to conduct annual follow-ups for specific high-risk groups, such as individuals with pulmonary hypertension, those facing higher social adversities and participants with poor HIV control.

Psychosocial Evaluation for Individuals With Upper Extremity Conditions: A Scoping Review—Part 1

Abstract Date Presented 03/21/24 This scoping review identifies psychosocial factors experienced by adults with upper extremity conditions that impede occupational performance. A preliminary conceptual model for psychosocial evaluation is explored. Primary Author and Speaker: Karrianna L. Iseminger

Patients’ perceptions matter: Risk communication and psychosocial factors in orthodontics

Effective risk communication is essential for achieving patient-centered oral health care, but the limited understanding of patients' subjective perceptions of orthodontic-related risks hinders this process. This study aimed to investigate adults' awareness, concerns, and risk-avoidance behaviors about long-term orthodontic risks, exploring their relationship with psychosocial factors. We included 498 adult patients (mean age, 27.3 ± 6.8 years; women, 75.5%) during their initial visits to the orthodontic department at a hospital in Chengdu, China. Participants' understanding of orthodontic risks was gauged before and after exposure to the Oral Health Education Comics (OHEC), a specifically designed digital tool. Concurrently, we used logistic regression models to investigate the associations between patients' depression, anxiety, self-esteem, perfectionism, and dentofacial esthetics with risk perceptions. Approximately 79.5% of participants initially reported low awareness of orthodontic risks, with most knowledge from online sources. Notably, the percentage of participants with high awareness increased to 64.8% after OHEC. The negative facial soft-tissue change was most concerning for participants: 53.4% showed high concerns, and 28.1% showed high avoidance. Furthermore, linear regression indicated positive associations between depression (β= 0.42 [95% confidence interval {CI}, 0.07-0.77]) and anxiety (β= 0.76 [95% CI, 0.35-1.18]) with orthodontic risk concerns, whereas risk avoidance was positively associated with depression (β= 0.62 [95% CI, 0.27-0.97]), anxiety (β= 1.09 [95% CI, 0.68-1.50]), and perfectionism (β= 0.24 [95% CI, 0.02-0.46]). Findings emphasize the imperative of streamlined risk communication in orthodontics. By incorporating comprehensible tools such as OHEC and integrating psychosocial evaluations, more refined patient-practitioner communication and psychosomatic-based dental care can be achieved.

Being highly sensitive person negatively impacts on cognitive and psychosocial fatigue in multiple sclerosis patients: A cross-sectional, monocenter study

BackgroundFatigue is a common symptom in Multiple Sclerosis (MS), but its determinants are not clarified yet. Sensory processing sensitivity (SPS) is a personality trait characterized by enhanced sensitivity towards endogenous and exogenous stimuli, and higher attention toward minimal stimuli, resulting in overarousal and fatigue. Objectiveto evaluate the association between SPS and fatigue in MS patients. Methods192 consecutive MS patients (age of 43.3 ± 12.1 years; females 67.2 %; median EDSS of 2.5 (0 – 7)) underwent clinical (EDSS, age, gender), cognitive (BICAMS, Trial Making Test [TMT]), psychosocial (Beck Anxiety Inventory [BAI], Beck Depression Inventory [BDI], Modified Fatigue Impact Scale [MFIS]) and sensitivity evaluation (Highly Sensitive Person [HSP]Scale). Patients were classified as HSP if the score was greater than 14. A stepwise regression model was applied to explore association between SPS and MFIS total scores and sub-scores, by accounting for age, gender, education, EDSS, Cerebral FS scores, TMT-Part A and part B scores, BAI, BDI, and Pittsburgh Sleep Quality Index (PSQI). ResultsTotal HSP was 17.2 ± 6.8 and 129 patients (67 %) were classified as highly sensitive persons (HSP). HSP patients were more female patients (p = 0.02) with a longer disease duration (p = 0.03). HSP people showed higher total MFIS score (27.6 ± 20.6 vs 13.2 ± 14.1, p < 0.001), higher physical MFIS score (p < 0.001), higher cognitive MFIS score (p < 0.001), higher psychosocial MFIS score (p < 0.001) vs non-HSP patients. Higher total MFIS was associated with SPS trait (coeff. 6.9, p = 0.006). Specifically, SPS trait was associated with higher cognitive MFIS (coeff. 5.3, p < 0.001) and higher psychosocial MFIS (coeff. 0.7, p = 0.02). ConclusionSPS was associated with fatigue. Since SPS could be easily and quickly assessed in clinical settings, SPS could unveil a higher propensity of a patient toward fatigue occurrence over the disease course and could provide hints for possible preventive cognitive behavior therapy.

Using tele-paramedicine to conduct in-home fall risk reduction after emergency department discharge: Preliminary data.

Older adults discharged from our emergency department (ED) do not receive comprehensive fall risk evaluations. We conducted a quality improvement project using an existing Community Tele-Paramedicine (CTP) program to perform in-home fall risk assessment and mitigation after ED discharge. High falls-risk patients, as defined by STEADI score >4, were referred for a CTP home visit by community paramedics supervised virtually by emergency physicians. Home hazards assessment, Timed Up and Go test (TUG), medication reconciliation, and psychosocial evaluation were used to develop fall risk mitigation plans. Outcomes assessed at 30 days post ED-discharge included: completed CTP visits, falls, ED revisits, hospital admissions, and referrals. Between November 2022 and June 2023, 104 (65%) patients were discharged and referred to CTP. The mean age of enrolled patients was 80 years, 66% were female, 63% White, 79% on Medicare or Medicaid, most lived with a family member (50%) or alone (38%). Sixty-one (59%) patients received an initial CTP visit, 48 (79%) a follow-up visit, and 12 (11%) declined a visit. Abnormal TUG tests (74%), home hazards (67%), high-risk medications (36%), or need for outpatient follow-up (49%) or additional home services (41%) were frequently identified. At 30 days, only one of the CTP patients reported a fall, one patient had a fall-related ED visit, and one patient was admitted secondary to a fall. A quality improvement initiative using CTP to perform fall risk reduction after ED discharge identified areas of risk mitigation in the home where most falls take place. Further controlled studies are needed to assess the impact of CTP on clinical outcomes important to patients and health systems.

Alcoholic Etiology, Severity of Liver Disease, and Post-Transplant Adherence Are Correlated with Worse Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in Liver Transplant Candidates.

Introduction: Psychosocial pre-transplant evaluation in patients undergoing liver transplantation (LT) could help identify those patients at higher risk of pharmacological non-adherence, organ rejection, and mortality. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated tool for assessing LT candidates' psychosocial well-being. Data on the ability of the SIPAT evaluation to predict post-transplant outcomes are sparse. Material and Methods: clinical and psychosocial data from a sample of 134 candidates for LT were analyzed. Moreover, the association between pre-transplant psychosocial evaluation and post-transplant clinical outcomes, including organ rejection, mortality, and immunosuppressant drug adherence, was calculated. Results: At the pre-transplant evaluation, patients who showed high SIPAT scores (77, 57%) also had more liver disease assessed by model for end-stage liver disease (MELD; F = 5.04; p < 0.05), alcoholic etiology (F = 35.80; p < 0.001), encephalopathy (F = 5.02; p < 0.05), and portal hypertension (F = 7.45; p < 0.01). Of the 51 transplant patients, those who had a high pre-transplant SIPAT score showed lower post-transplant immunosuppressive adherence, linked to more frequent immunological events. Conclusions: Patients with an alcoholic etiology of liver disease and more severe liver dysfunction are likelier to not adhere to medical prescriptions following transplantation. Current data suggests that this specific group of patients could benefit from early psychological pre-habilitation before undergoing liver transplantation.

Psychosocial Evaluation of Living Kidney Donors: A Survey of Current Practices in the United States.

Best practices in psychosocial evaluation and care of living donor candidates and donors are not well established. We surveyed 195 living kidney donor (LKD) transplant centers in United States from October 2021 to April 2022 querying (1) composition of psychosocial teams, (2) evaluation processes including clinical tools and domains assessed, (3) selection criteria, and (4) psychosocial follow-up post-donation. We received 161 responses from 104 programs, representing 53% of active LKD programs and 67% of LKD transplant volume in 2019. Most respondents (63%) were social workers/independent living donor advocates. Over 90% of respondents indicated donor candidates with known mental health or substance use disorders were initially evaluated by the psychosocial team. Validated psychometric or transplant-specific tools were rarely utilized but domains assessed were consistent. Active suicidality, self-harm, and psychosis were considered absolute contraindications in >90% of programs. Active depression was absolute contraindication in 50% of programs; active anxiety disorder was excluded 27%. Conditions not contraindicated to donation include those in remission: anxiety (56%), depression (53%), and posttraumatic stress disorder (41%). There was acceptance of donor candidates using alcohol, tobacco, or cannabis recreationally, but not if pattern met criteria for active use disorder. Seventy-one percent of programs conducted post-donation psychosocial assessment and use local resources to support donors. There was variation in acceptance of donor candidates with mental health or substance use disorders. Although most programs conducted psychosocial screening post-donation, support is not standardized and unclear if adequate. Future studies are needed for consensus building among transplant centers to form guidelines for donor evaluation, acceptance, and support.

Disparities in access to hematopoietic cell transplant persist at a transplant center

Disparities in access to hematopoietic cell transplant (HCT) are well established. Prior studies have identified barriers, such as referral and travel to an HCT center, that occur before consultation. Whether differences in access persist after evaluation at an HCT center remains unknown. The psychosocial assessment for transplant eligibility may impede access to transplant after evaluation. We performed a single-center retrospective review of 1102 patients who underwent HCT consultation. We examined the association between race/ethnicity (defined as Hispanic, non-Hispanic Black, non-Hispanic White, and Other) and socioeconomic status (defined by zip code median household income quartiles and insurance type) with receipt of HCT and Psychosocial Assessment of Candidates for Transplantation (PACT) scores. Race/ethnicity was associated with receipt of HCT (p = 0.02) with non-Hispanic Whites comprising a higher percentage of HCT recipients than non-recipients. Those living in higher income quartiles and non-publicly insured were more likely to receive HCT (p = 0.02 and p < 0.001, respectively). PACT scores were strongly associated with income quartiles (p < 0.001) but not race/ethnicity or insurance type. Race/ethnicity and socioeconomic status impact receipt of HCT among patients evaluated at an HCT center. Further investigation as to whether the psychosocial eligibility evaluation limits access to HCT in vulnerable populations is warranted.

The Psychosocial Evaluation of Living Kidney Donation: Time for Standardization in Practice.

The Psychosocial Evaluation of Living Kidney Donation: Time for Standardization in Practice.

Determinants of Prenatal Depression in Teenage Pregnant Women: A Comparative Study of Urban and Rural Settings in Lusaka Province, Zambia

Background: Perinatal depression manifests during or after pregnancy, with prenatal depression occurring during pregnancy. Traditionally, research has focused more on postpartum depression, with less attention on prenatal depression among teenagers. Objective: This study aims to examine the correlates of prenatal depression among teenage pregnant women aged 13 to 17 and to explore the relationship between these factors and depression. Methods: A cross-sectional study was conducted at a university teaching hospital and a rural health facility, involving 105 pregnant teenagers. Initial screenings to assess depression were performed using the Edinburgh Postnatal Depression Scale, complemented by psychosocial evaluations with the Perceived Stress Scale and the Rosenberg Self-Esteem Scale. Data analysis was carried out using SPSS version 20, employing both descriptive and inferential statistical methods to interpret the findings. Results: Significant factors influencing prenatal depression included attempts to abort, stress, social support, household income, education level, and marital status. Logistic regression confirmed the significance of these correlates. Conclusion: Multiple factors influence prenatal depression in teenage pregnant women. The findings highlight the need for targeted preventive care and early interventions by medical professionals to improve health outcomes for mothers and infants.

Developing a Mental Health Screening Questionnaire in an Asian Children's Hospital Emergency Setting.

Mental health concerns among adolescents are increasingly prevalent, yet underrecognized. Adolescents with psychological distress often present to the emergency department (ED) with somatic symptoms. Due to inadequate time for rapport building and lack of familiarity of ED clinicians with psychosocial evaluation, these concerns often get missed. We describe the development and implementation of the Youth Well Being (YWB) questionnaire, a self-administered psychosocial screening tool that aims to overcome the communication barriers to psychosocial evaluation. A multidisciplinary team used a Delphi-like approach to develop the questionnaire, using the home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources (HEADS-ED) questionnaire as the main reference. Modifications were made based on panel members' clinical experience and adapted to suit local sociocultural context. The YWB questionnaire is administered to adolescents aged 10 to 19 years presenting to the KK Women's and Children's Hospital ED with possible psychosomatic symptoms and behavioral or mental health issues. Positive findings prompt further targeted face-to-face interviews by the clinicians to facilitate appropriate psychosocial referral. The 9 domains in the YWB questionnaire explore potential psychosocial difficulties that affect the adolescent's well-being and aim to uncover potential issues that could account for the adolescent's symptoms. We discuss the rationale behind the questions and response options in the YWB questionnaire. The YWB questionnaire is the first initiative in Singapore to enable efficient psychosocial screening of at-risk adolescents in the ED. This communication tool can potentially be used in other health care settings to enable early recognition and intervention for adolescents distressed by psychosocial problems.

Utility of scores to predict alcohol use after liver transplant: Take them with a grain of salt.

The Sustained Alcohol use post-Liver Transplant (SALT) and the High-Risk Alcohol Relapse (HRAR) scores were developed to predict a return to alcohol use after a liver transplant (LT) for alcohol-associated liver disease. A retrospective analysis of deceased donor LT from October 2018 to April 2022 was performed. All patients underwent careful pre-LT psychosocial evaluation. Data on alcohol use, substance abuse, prior rehabilitation, and legal issues were collected. After LT, all were encouraged to participate in rehabilitation programs and underwent interval phosphatidylethanol testing. Patients with alcohol-associated liver disease were stratified by < or > 6 months of sobriety before listing. Those with <6 months were further stratified as acute alcoholic hepatitis (AH) by NIAAA criteria and non-AH. The primary outcome was the utility of the SALT (<5 vs. ≥5) and HRAR (<3 vs. ≥3) scores to predict a return to alcohol use (+phosphatidylethanol) within 1 year after LT. Of the 365 LT, 86 had > 6 months of sobriety, and 85 had <6 months of sobriety; 41 with AH and 44 non-AH. In those with AH, the mean time of abstinence to LT was 58 days, and 71% failed prior rehabilitation. Following LT, the return to drinking was similar in the AH (24%) compared to <6-month non-AH (15%) and >6-month alcohol-associated liver disease (22%). Only 4% had returned to heavy drinking. The accuracy of both the SALT and HRAR scores to predict a return to alcohol was low (accuracy 61%-63%) with poor sensitivity (46% and 37%), specificity (67%-68%), positive predictive value (22%-26%) with moderate negative predictive value (81%-83%), respectively with higher negative predictive values (95%) in predicting a return to heavy drinking. Both SALT and HRAR scores had good negative predictive value in identifying patients at low risk for recidivism.

Understanding the Healthcare Needs of Living Kidney Donors Using the Picker Principles of Patient-centered Care: A Scoping Review.

Living kidney donors (LKDs) undertake a complex and multifaceted journey when pursuing donation and have several unmet healthcare needs. A comprehensive understanding of these needs across their entire donation trajectory can help develop a patient-centered care model. We conducted a scoping review to synthesize empirical evidence, published since 2000, on LKDs' experiences with healthcare from when they decided to pursue donation to postdonation care, and what they reported as their care needs. We categorized them according to the 8 Picker principles of patient-centered care. Of the 4514 articles screened, 47 were included. Ample literature highlighted the need for (1) holistic, adaptable, and linguistically appropriate approaches to education and information; (2) systematic, consistent, and proactive coordination and integration of care; and (3) self-management and preparation to optimize perioperative physical comfort. Some literature highlighted the need for (4) better continuity and transition of care postdonation. Two key unmet needs were the lack of (5) a holistic psychosocial evaluation predonation and predischarge to provide emotional support and alleviation of fear and anxiety; and (6) access to specialty and psychosocial services postdonation especially when adverse events occurred. Limited literature explored the principles of (7) respect for patients' values, preferences, and expressed needs; and (8) involvement of family and friends as caregivers. We summarize several unmet healthcare needs of LKDs throughout their donation journey and highlight knowledge gaps. Addressing them can improve their well-being and experiences, and potentially address inequities in living kidney donation and increase living donor kidney transplantation.

Assessment of depressive symptoms among post stroke patients attending a Nigerian tertiary hospital

Background: Post Stroke Depression (PSD) occurs in a significant number of patients and constitutes an important complication of stroke, leading to greater disability as well as increased mortality. This study examined depressive symptoms among post stroke patients attending neurology clinic in a tertiary hospital in Northwest Nigeria. Methods: This cross-sectional study was carried out among 83 stroke survivors. Participants were administered socio-demographic, clinical characteristics pro-forma questionnaire and depression subscale of the Hospital and Anxiety Depressive Scale (HADS). Results: The 83 participants recruited for study had a mean age of 56.8 years (s.d. = 10.2) and 62.7 % were female. Majority (60.2%) had formal education, 83.1% were employed, and 73.5% were married. Overall, the prevalence of depressive symptoms was 34.9% while 2.4% were rated as having severe depressive symptoms. Unemployment, having disabilities and post stroke complications were significantly associated with depressive symptoms. Conclusion: The presence of depressive symptoms among stroke patients supports the need to consider routine screen for psychiatry morbidity among patients with medical condition that causes disabilities. Disability has been identified as the main predictor of depressive symptoms. In view of this, psychosocial evaluation and intervention should be integrated into clinical care of stroke patients for early detection of depressive symptoms.

(162) - Pre-Transplant Psychosocial Evaluation Characteristics and Associations with Pediatric Heart Transplant Outcomes

(162) - Pre-Transplant Psychosocial Evaluation Characteristics and Associations with Pediatric Heart Transplant Outcomes

A Dive into Delivery of Oral Hygiene Advice Based on the Personalized Oral Hygiene Advice Model.

Oral health's impact on overall well-being highlights the importance of preventive measures through effective oral hygiene practices. Currently, there is growing recognition of the need for customized oral hygiene advice depending on the patient's unique needs and circumstances. This narrative review addresses the gap in understanding the significance of personalized guidance through the proposal of the Personalized Oral Hygiene Advice Model (POHAM) as a comprehensive guide for oral health professionals. This model was developed to adapt to evolving patient demographics and diverse challenges, promoting a patient-centric and effective oral health approach. The POHAM comprises a flow chart of strategies from establishing a good rapport with patients, conducting comprehensive assessment through history-taking, psychosocial and technology proficiency evaluation, tailored education modules, and customized oral care product recommendations until the reassessment. These strategies aim to enhance patient engagement and adherence, as well as act as a guide for oral health professionals to use in the clinical setting before and during the course of oral treatment. Nevertheless, continued research, education, and technological advancements are needed to realize the full potential of personalized oral hygiene strategies, ensuring a transformative and sustainable oral healthcare landscape.

Optimization of Cardiorespiratory Fitness and Quality of Life in Women with Chronic Heart Failure after a Cardiac Rehabilitation Program

Introduction: Women with heart failure (HF) tend to experience a greater symptom burden and lower quality of life, possibly due to phenotypic differences and unique gender-associated risk factors. Despite evidence on the effects of cardiac rehabilitation programs (CRP) in the general population, there is underrepresentation of women in these programs. Additionally, the impact of CRP on cardiorespiratory variables obtained through cardiopulmonary exercise testing (CPET) and health-related quality of life (HRQoL) in women with HF remains unknown. Objective: To assess the impact of a CRP on cardiorespiratory fitness (CRF) in cardiorespiratory variables obtained through CPET and HRQoL in women with HF. Methods: A quasi-experimental study included HF patients who completed a CRP from June 2019 to December 2023. The CRP involved nutritional assessment, psychosocial evaluation, educational sessions, and concurrent training. It comprised 30 minutes of aerobic resistance training at 65-80% of heart rate reserve (HRR) and 30 minutes of strength training at 30-50% of 1-repetition maximum (1RM), with a frequency of 3 sessions per week for 4 to 6 weeks. CPET was conducted at the beginning and end of the program, analyzing cardiorespiratory variables. HRQoL was assessed using the SF-36 questionnaire. Gains in CRF and HRQoL at the end of the program in both men and women were analyzed. Results: Out of 217 included patients, 29.9% were women. At the program's onset, women showed lower exercise tolerance than men (workload 5.4±2.57 METs vs. 6.62±2.53 METs) and worse HRQoL (62.03%±18.37 vs. 68.38%±18.37). However, post-intervention, they optimized their CRF (%predicted VO2 [%VO2p] initial 56.62%±20.11 vs final 80.12%±30.32, p=&lt;0.001). Significant improvements in cardiorespiratory variables were observed in both cases: delta METs-load 3.02, p=&lt;0.001, delta peak oxygen consumption (VO2peak) 1.83 ml/kg/min, p=&lt;0.001, delta oxygen pulse (PO2) 1.21, p=0.021, delta cardiac power output (CPO) 1917, p=0.004, with a rightward shift in ventilatory thresholds and improvement in HRQoL (62.03%±18.37 vs. 78.81%±12.9, p=&lt;0.001) post-CRP. The only variable with no significant changes in either case was VE/VCO2 slope (delta -0.51, p=0.736). Additionally, in women with reduced left ventricular ejection fraction (&lt;50%), variables with no significant improvement included CPO (delta 959.22, p=0.283) and time to recovery of VO2 kinetics (TRCVO2) (delta -0.74, p=0.957). In patients with preserved left ventricular ejection fraction (≥50%), variables with no significant change included PO2 (delta 1.08, p=0.173), TRCVO2 (delta 26.82, p=0.099), and the first ventilatory threshold (VT1) (delta 0.09, p=0.504). Program attendance was 87.5% in both groups. Conclusion: Implementing a CRP in women with HF resulted in significant improvements in all evaluated cardiorespiratory variables (except for VE/VCO2 slope) and quality of life. These findings support the importance of ensuring women's access and participation in cardiac rehabilitation programs. Addressing existing barriers is crucial to maximize the long-term benefits of CRP in the female population with HF.